How TEVAR Surgery Saved the Life of One Unstoppable Equestrian

April 24, 2017 6:00 AM

Myra Fleming expects to be back in the saddle again after a thoracic endovascular aortic repair of her severely injured aorta. Learn how the surgery helped the octogenarian rider recover after an accident.

At age 83, Myra Fleming could run circles around many people half her age — and ride past them, too. An accomplished equestrian, she loved to enjoy the trails near her home.

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The otherwise healthy senior was doing just that in May 2016 when her horse suddenly began to gallop without warning.

Although she commanded the animal to stop, Fleming was thrown from the horse and landed on the side of the trail.

“I couldn’t move at first, and wondered if I had broken my neck,” she says. “Eventually, I could move, but I was getting weaker and weaker.”

Fleming had doubts that anyone would find her on the secluded path and feared she might die there. The day, however, proved to be filled with what Fleming considers “miracles,” beginning with a runner passing by who stopped to help and, in addition to calling 911, was able to reach her son.

Fleming remembers almost nothing of the two months that followed. She was taken to a local hospital near her home in Ortonville, Michigan, where doctors discovered a severe injury to her aorta caused by the fall.

Because of the nature of her injury, Fleming was referred to the University of Michigan Frankel Cardiovascular Center, where interventional radiologist Minhaj Khaja, M.D., and cardiac surgeon Karen Kim, M.D., evaluated her.

Proceeding carefully

According to Dr. Kim, Fleming’s CT scan showed blunt traumatic aortic injury.

Her proximal descending thoracic aorta had torn, and she was bleeding into her mediastinum — the area in the middle of the chest that houses the aorta, great vessels, airway, esophagus and heart.

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A decision was made to perform emergency thoracic endovascular aortic repair (TEVAR).

With TEVAR, a tube or sheath is inserted into the femoral artery, and through it, a wire is advanced into the thoracic aorta with X-ray guidance. A stent graft is delivered in a collapsed state through the sheath, positioned accurately using X-ray guidance, and then expanded to span and cover the site of aortic injury. 

As a result, the stent graft lines and reinforces the torn aortic wall to ensure continuity of blood flow and prevent further bleeding.

TEVAR has emerged as a minimally invasive and safer alternative to conventional open surgical repair for patients with traumatic aortic injury.

“In Myra’s case, this was especially true given her advanced age and the extent of bleeding that had occurred from the injury,” Dr. Kim says.

Plans to ride again

The accident and surgery haven’t sidelined the patient entirely. Fleming, a grandmother of five, says she’s feeling stronger every day.

The winter months have kept her off her horses (she currently has four) on her 10-acre property, but she plans to ride again one day.

Until then, she has become the proud owner of chickens. “They’ve kept me interested through the fall and winter,” she says.

Fleming says she also owes much to her four grown children, who provided care during her recovery.

“They have helped me immensely,” she says. “I am totally blessed.”